title: Development and validation of the Pediatric Anesthesia Behavior score--an objective measure of behavior during induction of anesthesia.
abstract: BACKGROUND
  Measuring perioperative behavior changes requires validated objective rating scales. We developed a simple score for children's behavior during induction of anesthesia (Pediatric Anesthesia Behavior score) and assessed its reliability, concurrent validity, and predictive validity.
  
  
  METHODS
  Data were collected as part of a wider observational study of perioperative behavior changes in children undergoing general anesthesia for elective dental extractions. One-hundred and two healthy children aged 2-12 were recruited. Previously validated behavioral scales were used as follows: the modified Yale Preoperative Anxiety Scale (m-YPAS); the induction compliance checklist (ICC); the Pediatric Anesthesia Emergence Delirium scale (PAED); and the Post-Hospitalization Behavior Questionnaire (PHBQ). Pediatric Anesthesia Behavior (PAB) score was independently measured by two investigators, to allow assessment of interobserver reliability. Concurrent validity was assessed by examining the correlation between the PAB score, the m-YPAS, and the ICC. Predictive validity was assessed by examining the association between the PAB score, the PAED scale, and the PHBQ.
  
  
  RESULTS
  The PAB score correlated strongly with both the m-YPAS (P < 0.001) and the ICC (P < 0.001). PAB score was significantly associated with the PAED score (P = 0.031) and with the PHBQ (P = 0.034). Two independent investigators recorded identical PAB scores for 94% of children and overall, there was close agreement between scores (Kappa coefficient of 0.886 [P < 0.001]).
  
  
  CONCLUSIONS
  The PAB score is simple to use and may predict which children are at increased risk of developing postoperative behavioral disturbance. This study provides evidence for its reliability and validity.
authors.affiliation: Department of Paediatric Anaesthesia, Bristol Royal hospital for Children, Bristol, UK.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Beringer
authors.forename: Rosemary
authors.initials: R
authors.lastname: Greenwood
authors.forename: Nicky
authors.initials: N
authors.lastname: Kilpatrick
mesh_terms: D000758:Anesthesia / Q000523:psychology*; D000762:Anesthesia Recovery Period; D000777:Anesthetics / Q000008:administration & dosage; D002648:Child; D002652:Child Behavior / Q000502:physiology*; D002653:Child Behavior Disorders / Q000209:etiology / Q000523:psychology; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D059035:Perioperative Period; D011183:Postoperative Complications / Q000523:psychology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D014081:Tooth Extraction / Q000379:methods
chemical_list: D000777:Anesthetics
keywords: anesthesia; anxiety; behavior; child; validation studies